Abstract
Bhagandara (~anal fistula) is a challenging surgical condition due to its high recurrence rate and anal incontinence. Acharya sushruta has explained surgical and para-surgical techniques for its management. Ksharasutra therapy is a time-tested para-surgical modality for Bhagandara with least recurrence (3.33%). Modified conventional technique of application of Ksharasutra is aimed to eliminate infected source and facilitate healing in short duration. A 30-year-old male patient presented with recurrent painful swelling with intermittent pus discharge from the base of the scrotum for one and half years. He underwent incision and drainage twice in the last six months. Magnetic resonance imaging revealed an anterior fistulous tract representing as St. James Type 1 Fistula, which varied from clinical features. He was treated with Modified Conventional Kshara Sutra Therapy (MC-KST) and whole length of fistulous tract was healed completely within five weeks. Anal fistula with scrotal extension is considered a complex manifestation to manage. In MC-KST method, tract was intercepted nearer to sphincter and infected crypto-glandular lesion was eradicated by Ksharasutra. The study concluded that MC-KST is one option to manage anal fistula with scrotal extension to preserve normal perineal structures.
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